Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan,
Dig Dis Sci. 2014 Aug;59(8):1909-16. doi: 10.1007/s10620-014-3115-5. Epub 2014 Mar 25.
Differentiation of gallbladder (GB) carcinoma from benign GB wall thickening is challenging. The recent introduction of second-generation ultrasonic contrast agents has made contrast harmonic imaging with EUS possible. The aim of our study was to evaluate the utility of contrast-enhanced harmonic EUS (CH-EUS) for the differential diagnosis of GB wall thickening.
Thirty-six consecutive patients with GB wall thickening imaged by CH-EUS and then underwent surgery were enrolled in this study. After the lesions were observed with conventional harmonic EUS (H-EUS), CH-EUS was performed with intravenous injection of 0.015 ml/kg of Sonazoid. Three reviewers with various levels of experience of EUS (Reviewer A: experienced endosonographer, B: EUS trainee, C: experienced gastroenterologist with expertise in transabdominal ultrasound but no EUS experience) were blinded to findings of recorded video of H-EUS and CH-EUS. The diagnostic accuracy of H-EUS and CH-EUS for malignant GB wall thickening was compared.
Final diagnoses based on surgical histology were GB carcinoma in 16, cholecystitis in 11, adenomyomatosis in 6 and cholesterolosis in 3. Overall sensitivity, specificity and accuracy for diagnosing malignant GB wall thickening of H-EUS and CH-EUS were 83.3 versus 89.6, 65 versus 98% (p < 0.001) and 73.1 versus 94.4% (p < 0.001). The inter-observer agreement for H-EUS was moderate (κ = 0.51), whereas that for CH-EUS was substantial (κ = 0.77). The inhomogeneous enhanced pattern on CH-EUS was a strong predictive factor of malignant GB wall thickening.
CH-EUS has the potential to improve the preoperative diagnostic accuracy and inter-observer agreement in the differential diagnosis of GB wall thickening.
鉴别胆囊（GB）癌与良性胆囊壁增厚具有挑战性。第二代超声造影剂的问世使得超声内镜下对比谐波成像是可能的。本研究旨在评估对比谐波超声内镜（CH-EUS）在鉴别胆囊壁增厚中的应用价值。
本研究纳入了 36 例经 CH-EUS 成像且随后接受手术的连续胆囊壁增厚患者。在进行常规谐波超声内镜（H-EUS）观察后，经静脉注射 0.015ml/kg 的 SonoVue 进行 CH-EUS。3 名具有不同 EUS 经验水平的观察者（观察者 A：经验丰富的超声内镜医师；B：EUS 学员；C：具有腹部超声专业知识但无 EUS 经验的经验丰富的胃肠病学家）对 H-EUS 和 CH-EUS 记录视频的结果进行了盲法评估。比较了 H-EUS 和 CH-EUS 对恶性胆囊壁增厚的诊断准确性。
根据手术病理诊断，最终诊断为胆囊癌 16 例、胆囊炎 11 例、腺肌增生症 6 例和胆固醇沉着症 3 例。H-EUS 和 CH-EUS 诊断恶性胆囊壁增厚的总体敏感性、特异性和准确性分别为 83.3%与 89.6%、65%与 98%（p<0.001）以及 73.1%与 94.4%（p<0.001）。H-EUS 的观察者间一致性为中度（κ=0.51），而 CH-EUS 的观察者间一致性为高度（κ=0.77）。CH-EUS 上不均匀增强模式是恶性胆囊壁增厚的一个强预测因素。
CH-EUS 有可能提高术前诊断准确性和观察者间一致性，有助于鉴别胆囊壁增厚。
